| NPI | 1750537825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME126728) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD452609) |
| 2085N0700X Radiology, Neuroradiology (Licence: MN 106810) | |
| 2085N0700X Radiology, Neuroradiology (Licence: MN 56807) | |
| 2085N0700X Radiology, Neuroradiology (Licence: PA MD452609) | |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2020-09-01 |